1902839293 NPI number — MEMORIAL HOSPITAL, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902839293 NPI number — MEMORIAL HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEMORIAL HOSPITAL, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902839293
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
149 HEALTH CARE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JELLICO
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37762-4433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-784-1206
Provider Business Mailing Address Fax Number:
423-784-1136

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
149 HEALTH CARE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JELLICO
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37762-4433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-784-2452
Provider Business Practice Location Address Fax Number:
423-784-1184
Provider Enumeration Date:
07/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MERKLIN
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
606-598-1035

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  00000000-16 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0447492 . This is a "JOHN DEERE HEALTH" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 100020437 . This is a "PHP COMPANIES" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 46166 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0447492 . This is a "PACIFICARE MCR" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3075983 . This is a "BLUECARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3075983 . This is a "TENNCARE SELECT" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0447492 . This is a "STERLING LIFE MCR" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0447492 . This is a "JOHN DEERE TENNCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 087482900 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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